Acne#

Plain-language guide to understanding acne types, severity, at-home care, prescription treatment options, hormonal acne, scarring, and what TeleTest can help with.

Acne is one of the most common skin conditions in Canada, affecting up to 85% of people at some point. With a stepwise plan and consistent care, most patients get clearer skin within a few months. This page covers what acne is, what makes it worse, what you can do at home, when prescription treatment is needed, and what TeleTest can help with.

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What acne is and what causes it#

Acne happens when the tiny openings in your skin (hair follicles, sometimes called pores) get clogged with a mix of oil (sebum), dead skin cells, and bacteria that live on the skin. Once a pore is plugged, the trapped material can swell, get inflamed, and form bumps. Four things drive it:

  1. Oil production. The oil glands in the skin become more active, especially during puberty or hormonal shifts.
  2. Clogged pores. Skin cells inside the pore stick together instead of shedding normally.
  3. Bacteria. A normal skin bacterium (Cutibacterium acnes) grows in the clogged pore.
  4. Inflammation. Your immune system reacts, causing redness, swelling, and tender bumps.

Acne is not caused by dirty skin. Scrubbing harder usually makes it worse.

Types of acne lesions#

You may see more than one type at the same time.

Type What it looks like
Blackheads Small, open clogged pores. The dark colour is from oxidized oil, not dirt.
Whiteheads Small, closed clogged pores under a thin layer of skin.
Papules Small, red, raised bumps without pus.
Pustules Red bumps with a white or yellow pus tip.
Nodules Larger, deeper, painful bumps under the skin.
Cysts Deep, painful, pus-filled lumps. Most likely to scar.

Blackheads and whiteheads are called non-inflammatory (comedonal) acne. The other types are inflammatory acne.

How bad is my acne? (mild, moderate, severe)#

Severity Typical features
Mild A few blackheads, whiteheads, or small pimples. Mostly on the face. Little redness. No scarring.
Moderate More frequent breakouts. Inflamed papules and pustules. May spread to chest, back, or shoulders. Some redness or dark marks.
Severe Many inflamed lesions, painful nodules or cysts. Multiple areas of the body. High risk of scarring or pigment changes.

Severity guides treatment. Most people who write off their acne as "just mild" actually have moderate acne and need more than over-the-counter products.

Hormonal acne, PCOS, and the menstrual cycle#

Adult acne in women often follows a hormonal pattern:

  • Breakouts that come and go with the menstrual cycle (often worse the week before a period).
  • Deep, tender bumps along the jawline, chin, and neck.
  • Resistance to topical treatments alone.
  • May come with other signs of high androgen activity such as unwanted facial hair, scalp hair thinning, or irregular periods.

Polycystic ovary syndrome (PCOS) is a common cause. If acne is paired with irregular periods, unwanted hair growth, or weight changes, it's worth screening for PCOS. Hormone testing is not routine for typical acne; it's reserved for women with these additional signs.

Triggers and what makes acne worse#

These don't cause acne, but they can make it flare:

  • Hormone shifts (puberty, menstrual cycle, pregnancy, starting or stopping birth control).
  • Stress. Stress hormones raise oil production.
  • Friction and pressure. Helmets, sports gear, tight straps, phone against the cheek, hands resting on the face.
  • Heavy or pore-clogging products. Look for the words "non-comedogenic" or "oil-free."
  • Picking or popping. Pushes inflammation deeper, causes scars, makes everything take longer to heal.
  • High-glycemic diet. Some people break out more with very sugary food, white bread, sweetened drinks. Dairy can also be a trigger in some.
  • Certain medications. Some steroids, lithium, certain seizure medications.
  • Sweating without rinsing. Especially on the chest and back.

At-home and OTC first steps#

Start here for mild acne, and continue these even if you go on prescription treatment.

Basic skincare routine#

  1. Cleanse twice daily with a gentle, fragrance-free, non-comedogenic cleanser. Lukewarm water. No scrubbing.
  2. Moisturize with a lightweight, oil-free moisturizer. Treatment products dry the skin and acne-prone skin still needs hydration.
  3. Sunscreen every morning. Mineral (zinc oxide) sunscreens are usually best tolerated. Most acne treatments make skin more sun-sensitive.
  4. Don't pick. Picking and popping cause most acne scars.

OTC active ingredients#

  • Benzoyl peroxide (over-the-counter, 2.5% to 5%). Kills the bacteria in clogged pores and helps unblock them. Start once daily on dry skin. Will bleach towels and clothing, so use white linens. Most people see improvement in 4 to 6 weeks. Start with the lowest strength.
  • Beta-hydroxy-acid cleansers or serums (lower strengths, OTC). Help unclog pores. Good for blackheads and whiteheads.
  • An over-the-counter retinoid gel (a vitamin-A-based topical, sold in pharmacies in Canada without a prescription). Apply a pea-sized amount at night. Expect dryness and possibly worse breakouts for the first 4 to 6 weeks before it gets better. Can be combined with OTC benzoyl peroxide, but apply at different times of day.
  • An OTC anti-inflammatory cream (lower strength). Helps with redness and dark marks. Gentler than benzoyl peroxide.

Give any new routine at least 8 to 12 weeks before deciding it isn't working.

When prescription treatment is needed#

See a clinician if any of the following apply:

  • Over-the-counter products haven't helped after 8 to 12 weeks.
  • You have moderate or severe acne (inflamed bumps, nodules, cysts, multiple areas).
  • Breakouts cause pain, scarring, or dark spots.
  • Acne is affecting your sleep, mood, or self-confidence.
  • You suspect hormonal causes (jawline pattern, cyclic flares, PCOS).

Prescription options come in tiers. TeleTest can help with most of them.

Tier 1: Prescription topicals#

These are applied to the skin and treat the underlying causes of acne. A clinician may prescribe one or a combination:

  • A prescription retinoid cream or gel (a stronger version of the vitamin A class). Unclogs pores, reduces inflammation, fades dark marks. Apply at night. Expect dryness and a possible "purge" (temporary worsening) in the first 4 to 6 weeks.
  • A prescription topical antibiotic. Calms inflamed bumps. Almost always prescribed together with benzoyl peroxide to prevent the bacteria from becoming resistant.
  • A prescription strength benzoyl peroxide + topical antibiotic combination. One tube does the work of two.
  • A prescription anti-inflammatory brightening cream (stronger than the OTC version). Good for sensitive skin and for fading dark marks. Safe in pregnancy.
  • A prescription hormonal topical (a newer cream that blocks oil glands from responding to hormones). An option for jawline or hormonal-pattern acne in any sex.

Expect 8 to 12 weeks for clear improvement. Don't switch products before 12 weeks unless you're getting irritation.

Tier 2: Oral prescription medications#

Used for moderate to severe inflammatory acne, or when topicals alone aren't enough.

  • A prescription oral antibiotic for acne (from the tetracycline class). Used in short courses, typically 3 months, alongside topical treatment. Reduces inflammation. Not safe in pregnancy or for children under 8. Can cause sun sensitivity. Should not be used long-term on its own.
  • Combined hormonal birth control. For women with hormonal-pattern acne. Some pills are specifically approved for acne in Canada. Discuss your medical history first (clotting risk, migraines with aura, smoking, blood pressure).
  • A prescription hormone-blocking pill (an oral medication that blocks the effect of androgens on the skin). Used in women with hormonal acne, often along with birth control. Requires a blood test for kidney function and potassium before starting and periodically after. Not used in pregnancy.

Tier 3: Severe acne (oral retinoid)#

For severe nodular or cystic acne, or acne that hasn't responded to other treatments, a prescription oral retinoid for severe acne is the most effective option. It requires:

  • Monthly visits and lab monitoring (cholesterol, liver enzymes).
  • For anyone who can become pregnant: two forms of contraception and monthly pregnancy tests, because this medication causes severe birth defects.
  • A formal in-person monitoring program.

TeleTest does not initiate this medication and does not make a referral for it. If your acne may need it, your TeleTest clinician can help you understand what the in-person process looks like and can provide a written summary of your treatment history, but you will need to find a local in-person clinician who runs an oral-retinoid monitoring program. Wait times can be long, so it's worth starting that search early.

Pregnancy and breastfeeding#

Many common acne treatments are not safe during pregnancy or while trying to conceive. Avoid:

  • All retinoids (prescription topical retinoids, OTC retinoid gels, the prescription oral retinoid for severe acne). Retinoids can cause serious birth defects.
  • Tetracycline-class oral antibiotics for acne. Can affect fetal teeth and bones.
  • Hormone-blocking pills for acne.
  • Combined hormonal birth control.

Safer options during pregnancy:

  • Gentle non-comedogenic cleansers and moisturizers.
  • An anti-inflammatory brightening cream (both OTC and prescription strengths are generally considered safe in pregnancy).
  • Benzoyl peroxide in small areas (face), in short bursts.
  • A prescription topical antibiotic (from certain antibiotic classes considered safer in pregnancy) when needed and discussed with your prenatal care team.

Always tell your TeleTest clinician if you are pregnant, breastfeeding, or trying to conceive.

Acne scars and dark marks#

Two different things often get called "scars":

  • Post-inflammatory hyperpigmentation (PIH). Flat dark or red marks left behind after a pimple heals. These fade on their own over 6 to 12 months. Daily sunscreen speeds this up. Prescription retinoids, prescription anti-inflammatory creams, and OTC products with niacinamide or vitamin C can help.
  • True scars. Indented (ice-pick, boxcar, rolling) or raised (keloid, hypertrophic). These don't fade on their own and need procedural treatment such as microneedling, chemical peels, subcision, or laser. This is cosmetic dermatology and isn't covered by provincial health plans.

The best scar treatment is preventing them in the first place. Treat moderate or cystic acne early. Don't pick.

If you have scars, our cosmetic dermatology resources cover the procedural options.

What TeleTest can and cannot offer#

TeleTest can:

  • Assess your acne and confirm the type and severity.
  • Prescribe prescription topicals (retinoid, topical antibiotic, combination products, anti-inflammatory cream, hormonal topical).
  • Prescribe oral acne antibiotics from the tetracycline class for moderate to severe inflammatory acne.
  • Prescribe a hormone-blocking pill for women with hormonal acne (with lab monitoring).
  • Prescribe combined hormonal birth control for hormonal acne when appropriate.
  • Provide follow-up consultations to adjust treatment, manage side effects, and step down to maintenance.
  • Provide self-pay lab requisitions when bloodwork is needed (e.g. before starting hormone-blocking pills).

TeleTest does not:

  • Initiate the prescription oral retinoid for severe acne. This needs in-person care with a clinician who runs a monitoring program for this medication. TeleTest does not arrange this referral - you will need to find a local in-person clinician yourself. Your TeleTest clinician can give you a written summary of your treatment history to bring with you.
  • Perform in-person procedures (extractions, injections, microneedling, lasers, chemical peels) or arrange referrals for them.

Common questions#

How long does acne treatment take to work?#

Most acne treatments take 8 to 12 weeks of consistent daily use before you see clear improvement. Switching products too soon is one of the most common reasons treatment "fails." Take a photo every 2 weeks under the same lighting so you can spot real change.

Can I treat mild acne on my own?#

Yes. A gentle cleanser, daily sunscreen, OTC benzoyl peroxide, and possibly an OTC retinoid gel at night is a solid starter routine. If you don't see clear improvement after 12 weeks of consistent use, that's the cue to book a consultation.

What's the difference between an OTC retinoid and a prescription retinoid?#

An OTC retinoid gel (available in Canadian pharmacies without a prescription) is a real retinoid and is effective for most mild acne. Prescription retinoids include stronger formulations and other related molecules from the same vitamin-A family - useful for moderate acne, deeper pores, or when the OTC option alone hasn't worked. A clinician can match the strength and formula to your skin.

Will my acne get worse before it gets better?#

Sometimes yes. Retinoids in particular often cause a "purge" in the first 4 to 6 weeks. Existing clogged pores rise to the surface as the medication speeds up skin turnover. Stick with the routine, use less product if it's irritating, and moisturize. If it's still worsening past 6 weeks, talk to your clinician.

Can I use benzoyl peroxide and a retinoid together?#

Yes, but apply them at different times: benzoyl peroxide in the morning, retinoid at night. Some retinoids are inactivated by benzoyl peroxide if mixed.

How do I deal with the dryness and irritation from retinoids?#
  • Start every other night for the first 2 weeks, then nightly.
  • Apply a moisturizer first, then the retinoid (this is sometimes called the "sandwich method").
  • Use only a pea-sized amount for the whole face.
  • Use a gentle, ceramide-based moisturizer twice daily.
  • Daily mineral sunscreen is mandatory (your skin will be more sun-sensitive).
Does diet matter?#

For most people, diet plays a small role. The strongest evidence is for high-glycemic foods (sugary drinks, white bread, sweets) making acne worse in some people, and possibly dairy (especially skim milk) in some. There's no need to cut out entire food groups, but a balanced lower-glycemic diet is reasonable. Chocolate and greasy food don't directly cause acne, despite the myth.

Does stress make acne worse?#

Yes. Stress hormones raise oil production and slow healing. You don't need to eliminate stress (impossible), but regular sleep, movement, and downtime help your skin treatments work better.

Do I need hormone testing?#

Not for typical acne. Hormone testing is useful when acne is paired with irregular periods, unwanted facial hair, scalp hair thinning, or weight changes that suggest a hormone imbalance like PCOS. Your TeleTest clinician will discuss this with you.

I have acne on my back and chest. Is it treated differently?#

Same principles, different application. Topical treatments are harder to apply to large areas of skin, so oral antibiotics or oral hormone-blocking pills are often used for moderate to severe truncal acne. Benzoyl peroxide body washes (used like soap, 4 to 5 minutes in the shower, then rinsed off) are a useful addition. Wear loose, breathable clothing and shower soon after sweating.

Can I pop a pimple?#

No. Popping pushes bacteria and pus deeper, makes inflammation worse, and is the single biggest cause of scarring. If a pustule needs draining, see a clinician.

What about laser, microneedling, and other in-office treatments?#

These are cosmetic procedures used mostly for scars and pigment changes after the acne is controlled. They are not first-line for active acne. Treat the active acne first.

I'm a teenager. Should I treat my acne, or wait to grow out of it?#

Treat it. Some people do grow out of acne, but moderate or cystic acne can leave permanent scars, and acne in your teens has a real impact on sleep and mood. Starting treatment early is one of the best ways to prevent scarring.

I'm in my 30s/40s and getting acne for the first time. What's going on?#

Adult-onset acne is common, especially in women, and often has a hormonal pattern (jawline and chin, cycles with periods). Stress, stopping birth control, perimenopause, or new medications can all be triggers. The treatments work the same way, and a hormone-blocking pill is often the most effective option in this group.

How do I prevent acne from coming back?#

Acne tends to come back if you stop everything as soon as your skin is clear. A maintenance routine keeps it away:

  • Keep using your retinoid (or a lower-frequency dose, e.g. 3 nights a week).
  • Continue benzoyl peroxide a few times a week.
  • Keep your sunscreen and gentle cleanser routine.
  • Re-treat early if you notice it creeping back.
My skin is sensitive. Won't acne treatments make it worse?#

Sensitive skin can handle most acne treatments if you go slowly: start low concentrations, every other night, with a good moisturizer, and avoid layering multiple actives at once. An anti-inflammatory brightening cream (OTC or prescription strength) is often the gentlest effective option.

Can I get acne treatment if I'm breastfeeding?#

Yes, with options. Generally considered safer in breastfeeding: an anti-inflammatory brightening cream, OTC benzoyl peroxide on small areas, and certain prescription topical antibiotic classes. Avoid all retinoids (topical and oral), the tetracycline-class oral antibiotics, and hormone-blocking pills. Your TeleTest clinician will discuss which option fits.

How much does a TeleTest consultation cost?#

The consultation fee is shown on the intake page. Your prescription is sent to the pharmacy of your choice (you can compare prices). For OTC products you buy directly. Cosmetic procedures (scar treatment, laser) are not covered.

What if my acne isn't getting better after 3 months on prescription treatment?#

Book a follow-up. There are several reasons treatment plateaus: incomplete adherence, wrong strength or class, a hormonal cause that isn't being addressed, or a different condition that looks like acne (rosacea, folliculitis, perioral dermatitis). A follow-up consultation lets your clinician adjust the plan.

I've heard about a strong pill for severe acne. Can TeleTest prescribe it?#

No. The prescription oral retinoid for severe acne requires monthly lab work, pregnancy testing for anyone who can become pregnant, and close in-person monitoring. TeleTest can help you understand if this is the right path and provide a clear summary of your treatment history to bring with you, but the prescription itself needs to come from a clinician who runs an in-person monitoring program for it. TeleTest does not arrange the referral - you will need to find a local in-person clinician yourself.

When to see in-person care urgently#

Most acne isn't an emergency, but go to a walk-in or your local urgent care if you have:

  • Sudden, severe acne with fever and joint pain. This can be a rare condition called acne fulminans.
  • A large, hot, spreading red area of skin (possible cellulitis - a deeper skin infection).
  • A painful cyst that's getting bigger over a few days and not draining, especially with fever.
  • An allergic reaction to a new product (widespread rash, swelling of lips or face, trouble breathing). Call 911 if breathing is affected.

For pregnancy planning while on retinoids or other acne medications, contact your clinician before stopping anything abruptly.

Cost and coverage#

  • Consultations: Self-pay. See the intake page for current pricing.
  • OTC products: You pay at the pharmacy.
  • Prescription medications: Some are covered by provincial drug plans (especially generics), some are partially covered, some are self-pay. Prescription retinoids, topical antibiotics, and oral antibiotics are often partly or fully covered through provincial plans or private benefits.
  • Cosmetic procedures (scar treatment, laser, peels): Not covered.
  • Bloodwork for hormone-blocking pills: Some bloodwork is covered under your provincial health plan when there's a clinical indication; some is self-pay. We'll explain the breakdown at the time.

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Last reviewed: Spring 2026. Reviewed by Dr. Mohan Pandit, Chief Medical Officer at TeleTest. We review this page periodically as medical guidelines, lab practices, and provincial programs evolve. This page is for general information, not personal medical advice. If you've noticed information that may be out of date or have suggestions, please contact us - we appreciate the help keeping these resources accurate.

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